Download Vietnamese Culture

Vietnamese
Culture
Page
CONTENTS
2
Communications
2
Traditional Family
Values
2
Health Care Beliefs
and Practices
5
Health Risks
6
Women’s Health
6
Youth Health
8
Special Events
8
Spiritual Practices
9
References and
Resources
BACKGROUND INFORMATION
Vietnam has a complex culture comprising ethnic Vietnamese, Chinese
(mostly Cantonese), Khmer, Hmong and a number of other minority groups.
Colonialism, like in most other Southeast Asian countries, wrought its
destruction and left its mark first by the Portuguese, then by the Dutch, the
English and most significantly by the French. Under French rule the
Vietnamese lost their script which was converted to the Roman alphabet (the
writing style is known as ‘quoc ngu’) and they found themselves secondclass citizens.
In an attempt to take control of Vietnam from the French (and Japanese) Ho
Chi Minh established the Vietminh in the North in 1942. Political battles
between North and South ensued, involving China, Japan, Britain and
France. In an attempt to end the conflict the Geneva accord of 1954 divided
the country by the 17th parallel into North and South. The North became
backed by Soviet aid and the South by US aid and military intervention, and
a long and devastating war saw the US retreating in 1973 after a cease-fire.
Shortly thereafter the communists took control of the country, already
ravaged by the horrors and violations of the war.
The first wave of refugees fled to the US in 1975. Most were urban
professionals associated with US interests in the South and were assisted by
US social agencies to resettle. The second wave, escaping the rising
repression and human rights abuses of the communist regime, left during
the late 1970’s to the mid 1980’s and included a higher number of less
educated people who suffered severe hardships in the exodus. Many of those
who survived the perilous boat journeys spent years in refugee camps before
being resettled. Many from the North went to Thailand, Indonesia, Hong
Kong, Malaysia and China, and from there to the US, or to other countries of
resettlement. The third wave, continuing into the 1990’s, left through UNHCR
assistance programmes based on their status as political prisoners (from ‘reeducation’ camps in Vietnam) and through family re-unification schemes.
Many continued to escape in boats. New Zealand has been a country of
resettlement since 1976, with the majority arriving between 1979 – 1980. A
small number have entered New Zealand since then as migrants, students or
to join their families.
Many Vietnamese have been severely challenged in their resettlement in
New Zealand by unresolved war- and post-war trauma, culture shock,
economic dependence, low English proficiency, poor pre-migration education,
and difficulty in accessing healthcare facilities. Second generation
Vietnamese still carry some of the unhealed wounds of their parents. It is
hoped that an understanding of this culture and the legacy of its immigrants
will facilitate better access to healthcare and culturally appropriate service.
Photo: Wikipedia (Gnu Free Licence).
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COMMUNICATION
Greetings
Hello
Goodbye
Xin Chao (pronounced ‘Sin Chow’)
Tam Biet (pronounced ‘Tam be it’)
Main language
Vietnamese (kinh) is the official language with 3 main dialects, and is generally
understood by most Vietnamese. It is a monotonic and complex language hybridized
from Mon-Khmer, Thai and Chinese. Some Vietnamese may speak French and some,
English. In addition there are 53 ethnicities all with their own dialects.
Specific gestures and interaction
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Use title and first names (e.g. Mr. Mark)
“Thua” (meaning ‘please’) is sometimes placed before the first name as a sign of
respect (this would be most appropriate with the older generations)
NB Direct eye contact is acceptable and in fact, expected (if no eye contact is
made, Vietnamese tend to ask themselves ‘what is s/he hiding?’)
Vietnamese smile and laugh easily, regardless of underlying emotion, so a
smile is not necessarily indicative of happiness
Vietnamese may not take appointment times literally
TRADITIONAL FAMILY VALUES
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There are often as many as 4 generations under one roof. The immediate family
(nha) includes nuclear family plus husband’s parents and grown sons’ spouses
and children. The extended family (ho) include family members of the same
name and relatives who lives close by
Individuals are oriented towards the good of the whole family and mutual
dependence is valued over independence
HEALTH CARE BELIEFS AND PRACTICES
Factors seen to influence health:
The diagnosis of illness is frequently understood from three different perspectives.
Vietnamese may often understand their illness as an interaction of these. One of the
implications is that treatments from all three models may be combined by the client
and this needs investigation by the practitioner.
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The first could be considered supernatural or spiritual, where illness can be
brought on by a curse or sorcery, or non-observance of a religious ethic.
Traditional medical practitioners, amulets and other forms of spiritual protection,
and religious practices may be employed in the treating of the illness. Buddhist
principles of acceptance of fate and the understanding that life involves suffering
will often influence clients to endure pain and illness and seeking help can be
delayed.
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Secondly, an obstruction of ‘chi’ (the life energy) or imbalance of the opposing
vital forces "Am" and "Duong" (similar to the concepts yin and yang, respectively
in China) can cause illness.
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The Western concept of disease causation is generally accepted although for
many there is a distrust of western practices (i.e. multiple techniques for
diagnosis and intervention) by more rural dwellers. Some (e.g. the H’mong),
believe that minor illness is organic whereas more serious illness has a
supernatural/spiritual cause.
Traditional treatment and health practices
Balance can be restored by a number of means, including dietary changes to
compensate for the excess of “winds” or imbalance in "hot" or "cold" states, western
medicines and injections, and traditional medicines. These practices and medications
include:
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Coining (cao gio)
Cupping (gia)
Pinching (bat gio)
Steaming (xong)
Balming
Acupuncture
Acupressure or Massage
Moxibustion (used mostly by the Mien, mountain dwelling cultures)
Herbal and Natural remedies
Magico-religious talismans in the form of amulets for protection
(See Chapter 2, Introduction to Asian Cultures, ‘Traditional treatments/practices’ pg
6, for additional information on some of the above practices).
Important factors for Health Practitioners to know when treating
Vietnamese clients:
1. People from rural areas who have had less exposure to western health care are
more likely to distrust the system and only present when traditional methods
have failed. It is important to check with clients about interventions already used.
2. The expectation of immediate symptom relief and cure is likely to be a goal when
entering the western health system. When a medication is not prescribed
initially, the patient is likely to seek care elsewhere. In addition to the
myriad of traditional healers and other traditional medicines and practices
available to resettled Vietnamese, Western pharmaceuticals, especially vitamins
and even antibiotics, are obtainable, either through specialized "injectionists," or
from relatives in other countries such as France where some of these medicines
are available without prescriptions. When medication is not an appropriate
intervention, treatment plans will need careful explanation by the practitioner.
3. It is reported in American literature that Vietnamese frequently discontinue
medicines after their symptoms disappear; similarly, if symptoms are not
perceived, it is believed that there is no illness. Hence preventive, longterm medications like anti-hypertensives must be prescribed with culturallysensitive education. It is quite common for Vietnamese patients to amass large
quantities of half-used prescription drugs, even antibiotics, many of which are
shared with friends and even make their way back to family in Vietnam.
4. It is often considered that Western pharmaceuticals are developed for westerners
whom they believe have a different physiological constitution. Often dosages are
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seen as too strong for the more slightly built Vietnamese, so self-adjustment and
discontinuation of dosages is not uncommon.
Some Vietnamese resist invasive procedures which they believe are potentially
harmful to the spirit. Less educated people often do not realize that more blood
can be produced by the body and think venapuncture will weaken them. These
issues will need to be clearly explained if treatment compliance is required.
Some traditional techniques (e.g. coining, cupping, moxibustion, pinching) may
leaves marks on the body and providers need to investigate these before
assuming abuse.
Vietnamese traditionally do not have a concept of ‘mental illness’ as distinct from
somatic illness. Mental illness is seen as a spiritually based illness and often
presents somatically.
When doing HOME VISITS:
• Give a clear introduction of roles and purpose of visit
• Check whether it is appropriate to remove shoes before entering the home
(notice whether there is a collection of shoes at the front door)
• If food or drink is offered, it is acceptable to decline politely even though the
offer may be made a few times
Diet and Nutrition
It is reported that many adults are lactose intolerant as they do not consume much
milk. Traditional diet is mostly rice, fish and vegetables, plus pork and chicken when
available. Fasting may be used when someone is sick with only hot water or thin rice
gruel consumed.
For some Vietnamese the diet is guided by the hot/cold foods of the Chinese
medicine system, and this will likely be followed when the person is unwell. It is
believed that some foods have medicinal value. Vietnamese clients will likely expect
a dietary element to be part of treatment.
Stigmas
Mental health is seen as a stigma with the result that family members suffering from
mental health symptoms may be hidden from the public (in New Zealand by the
family, but back home they are often abandoned in hospitals). Alternatively these
clients are likely to present with somatic symptoms.
Death and dying
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Beliefs and practice about death are strongly influenced by the Buddhist attitude
of equanimity. Dying with mindfulness and awareness is highly valued
Pain and other symptoms are often endured with stoicism. This is a critical issue
in caring for Vietnamese. It is necessary to ask very directly and specifically
about each symptom. Clients may elect for a greater degree of alertness over
complete pain control or being in a highly sedated state
Dying at home allows significantly greater cultural/community support than a
hospital death and ceremonies and visitations are very helpful to the family
The family will likely want to be present for the member’s last days. If the client
is hospitalized and is Buddhist, they should be told directly that a monk will be
welcomed by the institution. The presence of a monk is helpful to the client and
the family
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HEALTH RISKS AND CONCERNS
According to Metha’s (2012) report on health needs for Asian people living in the
Auckland region, the following were noted as significant 1:
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Stroke
Overall Cardiovascular (CVD) hospitalizations
Diabetes (including during pregnancy)
Child oral health
Child asthma
Cervical screening coverage
Cataract extractions
Terminations of pregnancy
In addition, Unexmundi, August 2014 lists the following as major infectious diseases
for Vietnam:
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Hepatitis A and E
Typhoid fever
Malaria
Dengue Fever
Yellow Fever
Japanese Encephalitis
African Trypanosomiasis
Cutaneous Leishmaniasis
Plague
Crimean-Congo hemorrhagic fever
Rift Valley fever
Chikungunya
Leptospirosis
Schistosomiasis
Lassa fever
Meningococcal meningitis
Rabies
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The Metha 2012 report refers to three ethnic groups stratified in the Auckland region:
Chinese, Indian, ‘Other Asian’ (includes Southeast Asian). Ethnicities include Korean, Afghani,
Sri Lankan, Sinhalese, Bangladeshi, Nepalese, Pakistani, Tibetan, Eurasian, Filipino,
Cambodian, Vietnamese, Burmese, Indonesian, Laotian, Malay, Thai, Other Asians and
Southeast Asians not elsewhere classified (NEC) or further defined (NFD)
Unless otherwise specified, the term ‘Asian’ used in this CALD resource refers to Asians in
general and does not imply a specific ethnicity or stratified group.
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WOMEN’S HEALTH
According to Metha’s (2012) report on health needs for Asian people living in the
Auckland region:
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Asian women have lower total fertility rates (TFR) in the Auckland region as
compared with European/Other ethnicities
All Asian groups had lower rates of live births than their European/Other
counterparts
Teenage deliveries occurred at significantly lower rates among the Asian groups
as compared to European/Other teenagers
Asian women have more complications in live deliveries because of diabetes
compared with European/other ethnicities
Asian women had lower rates of hospitalizations due to sexually transmitted
diseases than European/other ethnicities (but across all ethnic groups studied,
women had a much higher hospitalization rates compared to men)
Traditional health care needs and practices:
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Acceptance and knowledge of family planning will depend on the ethnic origins of
families. The contraceptive pill is not accepted by some as it is believed to be a
‘hot’ medicine which may cause handicaps in babies. IUD’s and rhythm method is
more commonly used in Vietnam. However, people more recently migrated, and
from urban regions are likely to be familiar with contraception since the
introduction of strong government policy and ‘two children families’
It is reported that resettled women in US seek conventional prenatal care when
pregnant. However pregnancy in an unmarried woman is considered
dishonourable to the family and so it is hidden or abortions may be sort
Husbands are not usually present at deliveries
Women whose beliefs are based on Chinese medicine (more often the lowland
peasant groups) may refuse to bathe, drink juices or water, or wash their heads
post partum so as not to create imbalances in the body, particularly considering
the loss of blood that occurs during delivery
Women are considered to be weak and vulnerable after delivery and rest and
quiet is preferred, ideally for up to a month
Women will usually breastfeed for the first 6 – 12 months
Women are reported to have higher rates of cervical cancer than for the rest of
the population in Australia, and it is also noted that they suffer disproportionately
from fractures
YOUTH HEALTH
Adolescent Health
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According to Metha’s (2012) report on health needs for Asians living in the
Auckland region:
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Alcohol consumption is less prevalent amongst Asian students as compared to
NZ European students
Almost all Asian youth reported good health
Most Asian youth reported positive relationships and friendships
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In addition, adolescents who migrate without family may encounter the following
difficulties:
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Most Asian youth reported positive family, home and school environments
40% of Asian youth identified spiritual beliefs as important in their lives
75% of Asian students do not meet current national guidelines on fruit and
vegetable intake
91% of Asian students do not meet current national guidelines on having one
or more hours of physical activity daily
Mental health is of concern amongst all Asian students, particularly
depression amongst secondary student population
Loneliness
Homesickness
Communication challenges
Prejudice from others
Finance challenges
Academic performance pressures from family back home
Cultural shock
Others who live with migrated family can face:
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Status challenges in the family with role-reversals
Family conflict over values as the younger ones acculturate
Health risks due to changes in diet and lifestyle
Engaging in unsafe sex (it is reported by local community members that even
if sex education is offered, some students may not attend as they do not want
to be seen to be attending such gatherings, particularly as word may get back
to the parents. Health practitioners may find it a useful opportunity when
consulting with Vietnamese adolescents to provide them with the needed
information)
Barriers to healthcare because of lack of knowledge of the NZ health system,
as well as associated costs and transport difficulties
Child Health
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According to Metha’s (2012) report on health needs for Asians living in the
Auckland region:
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There are no significant differences in mortality rates of Asian babies
compared to European/Other children
There were no significant differences in potentially avoidable hospitalizations
(PAH) as compared to other children studied
The main 3 causes of PAH amongst all Asian children studied were ENT
infections, dental conditions or asthma
The rate of low birth weights were similar amongst ‘Other Asian’ babies and
their European/Other counterparts
Asian children had similar or higher rates of being fully immunized at two and
five years of age as compared with European/Other children studied
A lower proportion of Asian five-year olds had caries-free teeth compared to
the other ethnic groups studied
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Traditional issues in child and youth health
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Filial obedience and respect of elders is very important
Corporal punishment is common in Vietnam and parents are often not aware that
this is unacceptable in New Zealand, nor how to manage their children when this
form of discipline is prohibited. Guidance by the health practitioner may be
needed, or AN appropriate referral
Children of survivors of torture and trauma may often display social withdrawal,
chronic fears, depression and dependence
SPECIAL EVENTS
‘Tet’ is the Vietnamese New Year. It is celebrated on the first day of the first month
on the lunar calendar, usually between 19 January and 20 February. The celebration
traditionally lasts 3 days. It is an important cultural celebration and much expense is
put into the event. It represents new beginnings and different religions have
contributed various rituals to the celebrations. Most clients would prefer not to be
hospitalized or to have diagnostic tests during this time as being with family is highly
valued.
SPIRITUAL PRACTICES
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Buddhism – this is practiced by most Vietnamese. Both Hinaya (south) and
Mahayana (north) forms are practiced
Confucianism
Taoism
Catholicism
Various forms of Shamanism
Cao Daism
This is a religion practiced only in Vietnam, largely in the Mekong Delta (about 2
million adherents) and is a synthesis of Buddhism, Christianity, Taoism,
Confucianism and Islam. It was founded in Southern Vietnam in the 1920’s and
was at that time a religion and a nationalist movement. The number of
practitioners within the movement are continually growing
(See Chapter 2, Introduction to Asian Cultures, pgs 12-16 for more information
related to religions and spiritual practices).
DISCLAIMER
Every effort has been made to ensure that the information in this resource is correct
at the time of publication. The WDHB and the author do not accept any responsibility
for information which is incorrect and where action has been taken as a result of the
information in this resource.
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REFERENCES AND RESOURCES
1. Allotey, P., Manderson, L., Nikles, J., Reidpath,D., Sauvarin, J. Vietnamese: A
Health Guide for Professionals. Australian Centre for International and
Tropical Health and Nutrition, University of Queensland. Retrieved June 2006
at: http://qhin.health.qld.health.qld.gov.au. Link no longer current.
2. Chao, P.C. (1996). Voices of the South Asian Communities - Mien. On-line.
(downloaded July 2006). Available at:
http://ethnomed.org/culture/vietnamese
3. Kemp, C., Rasbridge, L. (2004). Refugee and Immigrant Health. A handbook
for Health Professionals. Cambridge: University Press.
4. LaBorde, P. 1996. Vietnamese Cultural Profile. On-line. (downloaded July
2006). EthnoMed, University of Washington, Seattle, WA. Available at:
http://ethnomed.org/culture/vietnamese
5. Lim, S. (2004). Cultural Perspectives in Asian Patient Care (handout). Asian
Support services. Waitemata District Health Board.
6. Mehta S. Health needs assessment of Asian people living in the Auckland
region. Auckland: Northern DHB Support Agency, 2012.
7. Rasanathan, K. et al (2006). A health profile of Asian New Zealanders who
attend secondary school: findings from Youth2000. Auckland: The University
of Auckland. Available at: www.youth2000.ac.nz, www.asianhealth.govt.nz,
www.arphs.govt.nz
8. Rasbridge, L.A. Vietnamese. Retrieved July 2006 from:
http://www3.baylor.edu/~Charles_Kemp/vietnamese_health.htm Link no
longer currently at February 2015.
9. Trung Tran. 'Vietnamese', Te Ara - the Encyclopedia of New Zealand. On-line.
Retrieved August 2006. Available February 2015 at:
http://www.teara.govt.nz/en/refugees
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Additional Resources
1. The http://ethnomed.org/ site has patient education materials in Vietnamese
on various types of cancer, and on diabetes and exercise
2. The http://spiral.tufts.edu website has Patient Information by language with
many resources in Vietnamese
3. RAS NZ (Refugees As Survivors New Zealand) can provide assistance to
mental health practitioners on clinical issues related to refugee and cultural
needs, and contacts for community leaders/facilitators. They can be contacted
at +64 9 270 0870.
4. ARCC can provide information on resettlement issues and contacts for
community leaders. Contact +64 9 629 3505.
5. Refugee Services can be contacted on +64 9 621 0013 for assistance with
refugee issues.
6. The http://www.ecald.com website has patient information by language and
information about Asian health and social services.
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